RI COVID-19 Daily Press Conference: April 6, 2020

The press conference on Wed, Apr 8, will be at 2:30pm instead of the usual 1pm.

New Testing Facility

Gov. Gina Raimondo announced at her daily press conference that a new drive-through testing facility was now open and operating in the parking lot of the Twin River casino in Lincoln (which is otherwise closed). RI capacity is now more than 2,000 tests daily, “some of the highest testing per capita in America,” she said. All COVID-19 testing in RI is free to the patient and is offered without discrimination to all, including to undocumented patients the governor emphasized have nothing to fear.

At this time, only patients with symptoms meet the criteria for testing in RI, but everyone with symptoms is encouraged to seek testing. Symptoms of COVID-19 include any of: fever, cough, shortness of breath, muscle aches (myalgias), chills, runny nose or stuffy nose, sore throat, headache or diarrhea. Each infected person may experience any combination of different symptoms, or even no symptoms.

Anyone needing advice on any COVID-19 matter, including testing, can contact the RI Department of Health by telephone 401-222-8022 (every day including weekends, 8:30am-4:30pm), 211 (after hours), or by e-mail to RIDOH.COVID19Questions@health.ri.gov.

No one who believes they may have COVID-19 should just show up at a health care facility of any sort without making an appointment in advance, it was strongly emphasized.

There are now three separate testing regimens in RI, the governor explained:

1. Patients who are critically ill, in nursing homes or hospitalized will be tested by the state laboratory, which can turn around results within a matter of hours and has a capacity of 300 tests daily.

2. Patients who are RI residents and at least 18 years old can be tested at the drive-through Twin River facility. A partnership between state government and RI-headquartered CVS, this site has the newest machines approved just last week by the FDA that can provide test results within 30 minutes of taking the sample. It is staffed by licensed medical professionals assigned from the CVS MinuteClinic in-store facilities. This one site has a capacity of 1,000 tests daily. Patients can seek a test either with or without a referral from a medical practitioner at this CVS web page: cvs.com/minuteclinic/covid-19-testing

3. All other patients, including children, can be tested at any of the three drive-through facilities at the state colleges: CCRI in Warwick, RIC in Providence and URI in Kingston (South Kingstown). These are sample collection facilities only and results take 2 to 4 days from a commercial lab. These are staffed by National Guard medics (“Drive-Thru for COVID-19 Test”, by Maureen O’Gorman, Apr 1). These sites combined have a capacity of about 1,000 tests daily. Testing at these sites is only available with a referral from a medical practitioner. If someone does not have a PCP, they can call an urgent care facility (if they have health insurance) or a community health center (if they do not have health insurance).

Unemployment Insurance Applications

The recently passed federal stimulus legislation extends unemployment insurance eligibility to workers not otherwise eligible, such as independent contractors, gig workers, freelancers and small business owners.

Applications will begin to be accepted at 8am tomorrow on the state Department of Labor and Training (DLT) website: www.dlt.ri.gov (Note that “www” is required, and the web site does not appear to support “https”.)

UPDATE: The direct application link has been released: covidemergencyuibenefits.dlt.ri.gov

All workers who qualify for unemployment insurance due to the coronavirus pandemic will also receive an extra $600 weekly.

DLT is “crushed with demand” and bringing in added staff, so expect 1 to 2 weeks between applying and receiving first check. Do not call to inquire on status until 14 days have passed since application.

Religious Holidays

The governor again apologized and emphasized her personal regret about needing to cancel, with the co-operation of religious leaders, the usual activities of Christian Holy Week, including Palm Sunday through Easter, and of Jewish Passover that will start at sundown on Wednesday. Churches and synagogues have to be closed, “necessary to keep everybody safe.” Please limit the size of family gatherings to your immediate family you are already living with, anyway, the governor asked.

Daily Patient Census

Since yesterday there were two new deaths, for a total so far of 27, and 160 new cases, for a total so far of 1,082, of which 109 are currently hospitalized.

Of the 109 patients hospitalized, 37 were in ICU, of which 26 are intubated on ventilators.

“I’ve said all along these numbers are going to continue to go up. They’re not cause for alarm. They are certainly not cause for panic. They’re very consistent with what we are expecting, and I expect every day for the numbers to continue to increase for many weeks,” the governor said.

More than 1,300 tests were completed yesterday, said Dr James McDonald, the medical director and second-ranking official at the RI Department of Health (DoH). Of the new deaths, he said, one person was in their 80s and the other was in their 90s, the latter in a nursing home.

Everyone is asked to keep a private contact tracing notebook updated every day listing where you went and with whom you interacted, so if you do test positive you can provide this information to medical contact tracing teams who will notify those people so they can be tested. Data acquired for purposes of contact tracing is confidential protected health information and therefore covered by HIPAA, McDonald said.

This is the 37th day since RI identified its first patient.

Face Coverings

“If you’re in the critical infrastructure work force” you should be wearing a cloth-based face covering “all the time,” McDonald said. These can be very simple, bandannas and such. This strong recommendation includes workers in fire fighting, law enforcement, manufacturing, food and agriculture, and pretty much anyone still working. Face coverings are recommend for everyone.

The purpose of these face coverings is to prevent the wearer from infecting others when coughing, sneezing and speaking. They are not intended to protect the wearer.

Testing of People without Symptoms

In response to a question, McDonald said that we know that infected people shed virus two days before showing symptoms and therefore can infect others. This is partly why hand washing is so important.

“We would have loved to have” tested asymptomatic people, “but we haven’t had the testing capacity to do that and we’re not quite there yet. What we need to be doing right now is testing those with symptoms,” McDonald said. “As testing capacity expands even more, we might able to do something called ‘surveillance,’” which means testing the general population.

Medicaid Eligibility

Asked whether hospitals could implement “presumptive eligibility,” which would allow signing up a patient for Medicaid upon presentation with illness, the governor said, “Nobody should worry about whether they will have to pay for their hospitalizations.” The federal government has assured her that they are working to make sure no one, even uninsured people, has out-of-pocket medical expenses due to COVID-19. The details remain to be worked out, such as direct payments to hospitals or the state.

Clearance to Return to Work after Isolation

RI has not been re-testing patients following isolation, but has relied upon clinical indications: no symptoms and 72 hours free of fever without use of fever suppressants such as acetaminophen (Tylenol) or ibuprofen (Motrin), McDonald said. This follows CDC guidance.

Hydroxychloroquine

Asked about the use of hydroxychloroquine in RI, McDonald said, “Hydroxychloroquine has been in the news quite a bit as a treatment, and quite frankly we don’t know for sure if it’s an effective treatment, and I want to keep that right up front. I want a treatment as much as anyone else does, I really do. I just want you to know, as a doctor when I have a patient in front of me, it’s very reassuring to offer something that makes a person feel better, that’s partly why they come to see me, so I really want that. I think we need to be careful, though, about hydroxychloroquine. Dr. Fauci who runs the NIH, said ‘I’d like to see the science, I’d like to see the evidence.’ The Department of Health did issue emergency regulations about two weeks ago about how hydroxychloroquine could be used. We don’t have data yet about how successful it has been in RI. I know that in in-patients in the hospital, some of them have been given hydroxychloroquine, some have been given remdesivir, and some have been given some other medications. Kind of where I’m going with this is: Let the physicians who are tending to their patients be the physicians we know and trust them to be, and they’ll make the best decisions for their patients. As we get data that we feel confident we can share with you, we will share that with you. Right now, I don’t have any to tell you.”

When Will the Surge Come?

We don’t know but are getting ready, McDonald said.

Mathematical Modeling

The governor said, at length, “I want to address the question about modeling because I want people to really understand this.

“Right now, we are developing our own model here in Rhode Island. The folks at the Department of Health, some fantastic data scientists from Brown University, in consultation with the CDC, and we’re working on that. We’re also having a team at Johns Hopkins validate our model, and we’re in touch with the federal government and University of Washington. And there’s nothing perfect about it. It’s all based upon so many assumptions.

“No one, if anyone tells you they know exactly when Rhode Island’s peak is and what the number of hospitalizations will be at that peak, they’re not being honest with you. The reason is because it all depends. The single biggest variable in the model, the single biggest assumption, is the level of effectiveness of our social distancing. So if over the next two or three weeks people stay at home, don’t go to work unless absolutely necessary, 100% obey the quarantine if you’re ordered into quarantine – do not leave your house if you’re sick – etc., then our peak will be pushed out and will not be nearly as high. If, however, on a beautiful day people crowd around the parks, crowd at the beaches, crowd in line to get your takeout food, the peak will be sooner and worse, mortality will be worse. That’s just the brutal reality of this. So I think our peak could be anywhere between mid-to-late April and mid-May.

“But that changes every day. I’m trying to be as transparent as possible with people. It’s all deeply dependent on how much each and every one of us does what we’re told right now. And that’s each and every one of us. It also depends on us, we as a state, continuing to get better testing and, as soon as people are positive, get them into isolation and enforce that isolation. We have to ramp up our food delivery. So as Dr. McDonald said, we literally have an army of people working around the clock to ready our system, and every one of these factors will influence how bad it is and when it is.”

In response to a question from Motif after the press conference about details on the state’s developing model, the governor recommended the Institute for Health Metrics and Evaluation (IHME) website operated by the University of Washington: covid19.healthdata.org/projections